Salivary Infections

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Salivary Infections

• Viral endemic Parotitis (Mumps)
• Bacterial Sialadenitis

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Mumps (Viral endemic parotitis)

• Mumps is an acute sialadenitis which caused by an
  RNA virus
• This RNA virus is the paramxovirus
• Other virus which can cause salivary infections
  are
• Cytomegalovirus
• Coxsackieviruses
• Echovirus

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Mumps (Viral endemic parotitis)

• CLINICAL FEATURES
• Airborne droplets transmit mumps virus
• It mainly effects the parotid gland.
• Children between the ages of 5-18 years are
  infected the most.
• Once exposed the patient will develop the disease
  within 2-3 weeks
• There is rapid swelling of the parotids
  bilaterally
• There is an acute pain while salivation.
• 
  contd

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Mumps (Viral endemic parotitis)
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Mumps (Viral endemic parotitis)

• The ear lobe is elevated as there is glandular
  enlargement.
• There may be a purulent discharge from the
  parotid duct but it is clear and unremarkable.
• As the acini become infected the salivary amylase
  leaks into the interstitium and is absorbed in
  the blood stream raising the serum amylase
  levels
• Severe form of parotitis can lead to sterility.

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Mumps (Viral endemic parotitis)

• HISTOPATHOLOGY
• The acini develop cloudy swelling making the
  connective tissue edematous
• There is infiltration with plasma cells and the
  lymphocytes
• The ductal lumens contain desquamated cell debris
  and leukocytes .

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Mumps (Viral endemic parotitis)
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Mumps (Viral endemic parotitis)

• TREATMENT
• There no effective antiviral therapy available
  for the treatment of mumps.
• Analgesics and antipyretics are given to control
  pain and fever
• Liquid diet with vitamins should be considered
• There should be complete bed rest.

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Bacterial Saladenitis

• Bacterial saladinitis usually occurs after
  surgery most commonly abdominal surgery.
• The possible reason may be temporary lack of
  ductal flow which can develop while atropine
  sulphate is administered while delivering general
  anesthesia which allows ascending infections and
  thus pyogenic bacteria can inhibit the ducts.
• Due to this there is pain and swelling .
• Purulent exudate can be expressed from the
  orifice of the duct.

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Immune Mediated Salivary Gland Diseases

• Lymphoepithelial saladenitis
• Sjogren syndrome

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Sjogren syndrome

• It is a group of autoimmune conditions with a
  marked predilection for woman, it has an intense
  T lymphocyte mediated autoimmune process in
  salivary and the lacrimal glands as on of its
  most prominent component .
• Sjogren syndrome exhibits T cells infiltration
  and replaces the glandular parenchyma .

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Sjogren syndrome

• CLINICAL FEATURES
• It usually occurs in 0.5 1.0 of the
  population.
• This disease is not hereditary but certain
  genotypes have been identified.
• Primary sjogren syndrome only effects the
  salivary glands and the lacrimal glands
• Patients show kerato conjunctivitis.
• Secondary sjogren syndrome exhibits other signs
  of autoimmune disease , of which the common are
• 
  cont..d

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Sjogren syndrome
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Sjogren syndrome
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Sjogren syndrome

• Rheumatoid arthritis.
• Collagen vascular disease
• Lupus erytmatosis
• Systemic sclerosis
• Mixed connective tissue disease .
• The risk of developing extra salivary malignant
  lymphoma is increased.

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Sjogren syndrome

• 45 of SS patients have bilateral parotid
  swellings and the gland feels firm.
• Some patients have involvement of the parotid
  gland and as well as the submandibular gland.
• The most significant feature of SS is the dry
  mouth (xerostromia) and dry eyes (xeropthalmia)
• Dry mouth and dry eyes have there own
  implications which are quite annoying.

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Sjogren syndrome

• INVESTIGATIONS
• Blood complete picture will show raised ESR
• Serological test for rheumatoid arthritis
• Schirmers test for lacrimation.
• Contrast sialography
• MRI of the gland
• CT scan
• Finally biopsy for conclusive diagnosis.

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Sjogren syndrome

• HISTOPATHOLOGY
• Immuno- marker studies shoe the presence of the B
  and the T lymphocytes.
• The T lymphocytes are more in number
• As the is increased infiltration of the
  lymphocytes the is more acinar destruction.
• There is hyperplasia of the myoepithelial cells
  resulting in islands which no longer contain
  ductal lumens

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Sjogren syndrome
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Sjogren syndrome

• TREATMENT
• There is no effective therapy for SS.
• Xerostromia become worse with time artificial
  saliva may be used to reduce the discomfort.
• Usage of chewing gums to increase salivation has
  also shown some promise.
• Dry eyes are managed by using eye drops
  (pilocarpine)
• Root caries is managed by fluoride applications
  and filling materials.
• Candidasis is managed by using anti-fungal
  drugs.